Provider Demographics
NPI:1124617931
Name:REYES AGUILERA, DAYMARA
Entity type:Individual
Prefix:
First Name:DAYMARA
Middle Name:
Last Name:REYES AGUILERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7790 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4163
Mailing Address - Country:US
Mailing Address - Phone:786-641-1108
Mailing Address - Fax:
Practice Address - Street 1:13301 SW 132ND AVE UNIT 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6190
Practice Address - Country:US
Practice Address - Phone:786-713-5553
Practice Address - Fax:786-713-5559
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-133765106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician